Exploring the Dimensions of Mental Healthcare Accessibility for Vulnerable Migrant Groups and Actions to Improve Access: A Qualitative Study Conducted in Munich, Germany

Background: The experience of migration is often associated with stressors that affect mental health. Furthermore, migrants face barriers to accessing mental healthcare. This study aims to explore the dimensions influencing mental healthcare access for migrants in Munich, Germany and to develop recommendations for action. Methods: The study used a two-phase qualitative approach. Phase 1 included individual interviews with 24 migrants from three vulnerable groups (students, refugees, and LGBTQ+ people). Based on the data gathered, seven interviews with health professionals experienced in mental health services for migrants were conducted in Phase 2. The framework from Levesque et al. was applied for analyzing and conceptualization of the dimensions of healthcare access. The health professionals’ proposed actions were grouped based on their respective levels as macro, meso, and micro. Validation was achieved by reviewing the data analysis during a meeting attended by all authors and a professional who was not involved in the interviews. Results: The dimensions of mental healthcare access encompassed: 1) ability to perceive mental problems, including stigma and knowledge about mental health; 2) ability to seek care, encompassing knowledge about the new healthcare system and social support; 3) acceptability of services, involving provider identity and gender; 4) availability and affordability, including insurance coverage, bureaucratic processes, and capacity and geographical distribution of services; 5) appropriateness including providers’ and patients’ understanding of mental healthcare, and providers’ competence. Language and culture exhibited a strong interplay across all dimensions. The analysis yielded 17 action recommendations. Macro-level recommendations target barriers caused by discrimination and inequality. Meso-level recommendations included increased care capacity and coordination and eliminating language and culture barriers in health services. The micro-level recommendations included activities to promote mental health. Conclusion: Migrants face numerous barriers to mental healthcare due to health system and providers in Munich. However, culture and language remain the most important access factors, necessitating social support. Actions pertaining to acceptability, accessibility, affordability, and appropriateness of health services are required to ensure that all individuals, including migrants, have access to mental healthcare. However, improving migrant mental health begins with the removal of structural barriers created by discrimination and inequality at the macro level.